cardiovascular disease

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Study: Despite Weight Gain, Quitting Smoking Improves Heart Health For Mentally Ill After A Year

(kenji.aryan/flickr)

(kenji.aryan/Flickr)

The health profile for people with serious mental illness is pretty grim. In general, they have a lower life expectancy — 25 years less than the general population — which is largely due to cardiovascular disease related to high rates of obesity and smoking.

But a new study by researchers at Massachusetts General Hospital found that after one year, seriously mentally ill patients who quit smoking — even though they gained about 10 pounds — had a lower risk of developing heart disease compared to those who didn’t quit. That’s the good news part of the research, published online in The Journal of Clinical Psychiatry. The bad news is that if those people — who already have high rates of obesity — continue to gain weight, it’s fairly likely they will develop a slew of other health problems, including cardiovascular disease, said the study’s lead author, Dr. Anne Thorndike, an assistant professor at MGH and Harvard Medical School.

“Quitting smoking is the single most important behavior change that anyone, [including] people with serious mental illness, can do to reduce their risk of developing cardiovascular disease,” Thorndike said in an interview. “But the weight gain is a red flag. The story’s not over at one year … If they continue to gain weight, all the health factors will worsen and contribute to higher rates of cardiovascular disease.”

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Dementia Cases May Be Declining, Researchers Report, And Improved Heart Health Could Be Key

Decima Assise, who has Alzheimer's disease, and Harry Lomping walk the halls, Friday, Nov. 6, 2015, at The Easton Home in Easton, Pa. (Matt Rourke/AP)

Decima Assise, who has Alzheimer’s disease, and Harry Lomping walk the halls, Friday, Nov. 6, 2015, at The Easton Home in Easton, Pa. (Matt Rourke/AP)

Don’t misread this new report: the number of people expected to develop all types of dementia is still expected to skyrocket in the coming years, with estimates of more than 13 million older adults in the U.S. afflicted with Alzheimer’s disease by 2050.

But the report offers what researchers call “cautious hope.”

The analysis, based on data from the Framingham Heart Study (FHS), and published in The New England Journal of Medicine, suggests that the rate of new cases of dementia may be declining. Over a period from the late 1970s until the early 2000s, researchers report about a 20 percent reduction in dementia cases per decade. One potential reason: What’s good for your heart is also good for your brain.  And the report finds that among the Framingham study participants, at least, overall heart health has generally improved over the decades. (Though obesity and diabetes prevalences have not.)

Claudia Satizabal, the study’s lead author and an instructor of neurology at the Boston University School of Medicine, said in an interview that “with this study, what we’re showing is that we could potentially prevent some cases or delay the onset of [dementia] with improved cardiovascular health.” But, she warned, while the study points to improved heart health as a potential factor in the improved dementia outlook, “we need more research to identify which other factors have contributed to this decline so that we can extend this beneficial trend.”

Researchers began tracking cognitive decline and dementia in the FHS participants beginning in 1975 and into the present; for the current study they rely on data from about 5,000 participants. This analysis involved dividing the years into four time periods — the late ’70s, late ’80s, ‘1990s and 2000s. The researchers estimated the incidence of dementia at any given age in each of those periods for five years.

“We found that there has been a progressive decline in the incidence of all dementias,” Satizabal said. “If we compare to the late ’70s, we observe a decline of 22 percent in the late ’80s, then a 38 percent decline in the 1990s and a 44 percent decline in the 2000s.”

Notably, she said, the decline was more pronounced with a type of dementia caused by strokes. And also notably, the decline was only seen among participants with a high school diploma or above. Higher education, Satizabal said, can often be related to a better quality of life, and better vascular health overall.

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Debating Vitamin D: Leading Docs Still Wrangling On Best Dose For Patients

(Suzanne Schroeter/Flickr)

(Suzanne Schroeter/Flickr)

The message on vitamin D is pretty clear if you talk to Dr. JoAnn E. Manson, M.D., chief of the preventive medicine division at Brigham and Women’s Hospital in Boston, who is leading the largest clinical trial in the world investigating the potential health benefits of vitamin D. It boils down to this: Curb Your Enthusiasm. At least for the time being. Even in the midst of a hellish winter when you may be tempted to take an extra dose of the so-called “Sunshine Vitamin” for a boost.

In a commentary piece published this week in the Journal of the American Medical Association, Dr. Manson urges caution. She says that even though the public has become smitten with vitamin D, its growing popularity has led to mega-dosing that’s not backed by the current evidence. “More isn’t always better, more is sometimes worse,” Manson said in an interview. “We don’t yet have the answers, so we shouldn’t make assumptions.” But, she adds, in a couple of years, gold-standard evidence on whether higher doses of vitamin D are good for you should be out.

But get on the phone with Dr. Michael F. Holick, Ph.D., M.D., a leading vitamin D proponent, endocrinologist at Boston Medical Center and professor at Boston University School of Medicine, and you’ll get a totally different, but equally clear message. Vitamin D deficiency and insufficiency are far more widespread than certain professional medical groups suggest, Holick says, and dosing at higher levels shows “no evidence of toxicity.”

How did we get here and what’s a patient to do?

Here’s a little background:

In debates over nutrition, vitamin D is one of those supplements that’s drawn both passionate supporters and equally aggressive skeptics over the years. And, like coffee, chocolate and red wine, it’s often the subject of studies that can make your head spin: it’s good for you…until it’s not.

The current vitamin D guidelines from the Institute of Medicine recommend 600 IU’s per day for adults up to 70 years old and 800 IU’s per day for those over 70. “This,” writes Manson in her JAMA piece “is equivalent to 3 to 4 daily servings of fortified foods such as milk, yogurt, soy beverages, orange juice, or cereal, plus fatty fish twice per week. These amounts are adequate for at least 97.5% of U.S. and Canadian residents, she says, and it’s good even in the bleakest, darkest season, “even if you’re in Antartica in winter.” Continue reading